Surgery

Improvements in the Nineteenth Century

Problems before 19th Century

• Your chances of surviving any operation before the 19th Century were slim:– Pain

• No anaesthetics to knock you out. You were conscious throughout the operation (unless you passed out due to the pain)

– Infection• No understanding of the Germ Theory and how germs

were responsible for infection

– Blood Loss• Difficulties in controlling bleeding and the inability to

replace lost blood

Problem 1: Pain

• Read Source 2 page 134

• Problems of pain for the doctor– Patient kicking and flailing

• Successful doctors were fast doctors

– Shock• The patient could die from the effects of the

operation

Overcoming the problem of Pain

• General Anaesthetics– Ether (laughing gas)

• Discovered in 1799• Medical students used to have laughing gas parties!• Dentists used the gas first• John Warren was the first to use it in an operation in

the USA in 1846.

– Problems with Ether• Irritated the lungs (causing coughing in many patients)• Could combust and even explode easily

Overcoming the problem of Pain

• General Anaesthetics– Chloroform

• In 1847 James Simpson and some assistants experimented with some chemicals to try to find a safer anaesthetic

• When they awoke unconscious from under the table, they realised that they had found the right ingredients

– Problems with Chloroform• The dosage had to be regulated – too much could kill the

patient• The doctor had to be careful not to anaesethize himself• The successful knocking out of the patient meant that doctors

could try more complicated operations– Carry infection deeper into the body– More blood loss

– Royal Assent• When Queen Victoria used chloroform during childbirth in

1857, opposition to the use of it dropped away.

The Problem of Infection

• Pre Germ Theory– No-one could explain

how infection was caused

– Look at Source 1 page 134

• Note down all the possible sources of infection

– Even with an anaesthetist infection was still possible

Overcoming the problem of Infection

• Ignaz Semmelweis– Hungarian Doctor– Women and Childbirth

• He noticed that death rate was lower for midwives than for doctors coming from the Post-Mortem room

• In 1847 he posted a sign (page 137) that said that ALL doctors had to wash their hands before entering the maternity ward.

Overcoming the problem of Infection• Joseph Lister

– Influenced by Pasteur’s

Germ Theory– Anti-Septics

• Carbolic Spray– Lister had seen that it was used to treat sewage

– He used it together with careful bandaging

» Effects graph page 138 source 15

– Aseptic Operating Theatres• Koch discovers the germ that carries septicaemia in 1878• Lister applied this knowledge to cleaning operating

theatres and hospitals to remove all traces of the germ

The Aseptic Hospital

The Problem of Blood Loss• Bleeding was difficult to control

– Tourniquet– Raise wound– Direct pressure

• Lost Blood could not be replaced– Transfusions failed

• Clotting• Blood Types not understand

• Infection was often introduced when trying to control blood loss– Eg Pare’s ligatures

Overcoming some of the problems of Blood Loss• Joseph Lister (Again)

– Uses sterilised Catgut for ligatures• Infection cut down• Blood loss could be controlled during and

after the operation

The Impact of the First World War on Surgery

• Plenty of Practice!• New Industrial Warfare

– Bullet Wounds• High powered Rifles• Machine Guns

– Artillery Rounds• Shrapnel

– Filthy living conditions

• The Surgeon was kept busy!• Generals wanted their soldiers back in the

line ASAP– Invested money, personnel and expertise

X-Rays - X marks the spot!

• Discovered in 1895 by Wilhelm Rontgen– He noticed that some Cathode Rays passed

through paper, wood and even flesh– However, they did not pass through metal or

bone• Hospitals experimented with the new

machine before World War One• The War proved their true worth

– Surgeons could quickly and accurately locate bullets and shrapnel

– They did not need to do explorative surgery

Blood Transfusion• 1901 – Blood groups discovered

– However Transfusions had to be done immediately or the blood clotted

• Battlefield– Immediate transfusions often impractical– They needed to find a way to store blood

• Plasma discovered – The liquid part of the blood could be separated

from the clotting particles of the blood.– Just add warm saline and the plasma is ready to

use as blood!

Fighting infection• Gangrene a terrible problem for wounded soldiers• Surgeons discovered that if they cut

away all infected tissue and soaked the wound in saline, they could prevent the spread of gangrene.

• This was the only way to deal with gangrene – no medicines could yet kill any infections!

Other Advances

• Skin grafting improved• Eye surgery improved• Broken bone setting improved• ENT surgery improved• Brain surgery attempted• First attempts at dealing with

Post-Traumatic Stress Disorder